Beyond screening for domestic violence - A systems model approach in a managed care setting

Background; Implementation of screening guidelines for domestic violence ha s been challenging. The multifaceted "systems model" may provide an effecti ve means to improve domestic violence screening, identification, and interv ention in the healthcare setting. Methods: We developed: (1) a systems model approach using tools for effecti ve referral, evaluation, and reporting of domestic violence; (2) materials for distribution to female patients; (3) training for social service and me ntal health clinicians to provide domestic violence evaluation; and (4) str ong links to the community. Setting: A nonprofit, managed care facility in Richmond, California. Participants: Staff and members of the managed care plan. Main Outcome Measures: (1) Increased screening for domestic violence by cli nicians; (2) increased awareness of the healthcare facility as a resource f or domestic violence assistance; and (3) increased member satisfaction with the health plan's efforts to address domestic violence. Results: The number of clinician referrals and patient self-referrals to an on-site domestic violence evaluator increased more than twofold. A pre-int ervention and post-intervention phone survey of members seen for routine ch eckup showed an increase in member recall of being I asked about domestic v iolence. After intervention, statistically significant increases were seen in members' perception that the health plan was concerned about the health effects of domestic violence (p <0.0001) and about members' satisfaction wi th the health plan's efforts to address this issue (p <0.0001). Conclusions: A systems model approach improved domestic violence services i n a managed care health setting within I year and affected clinicians' beha vior as well as health plan members' experience. This successful implementa tion makes it possible to address critical research questions about the imp act of a healthcare intervention for victims of domestic violence in a mana ged healthcare setting.